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Management of Treatment-Resistant Obsessive-Compulsive Disorder

  • Anxiety, Obsessive Compulsive, and Related Disorders (CB Nemeroff, Section Editor)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Opinion Statement

Purpose of review Many individuals with obsessive-compulsive disorder (OCD) do not fully respond to first-line treatments (psychotherapy consisting of exposure and response prevention [EX/RP] and serotonin reuptake inhibitor [SRI] pharmacotherapy). These cases are often considered “treatment-resistant” OCD. In this article, we offer a heuristic guide for treating clinicians for such cases.

Recent findings Clinical options for treatment-resistant OCD include augmenting first-line treatments with medications, psychotherapy, and neuromodulatory approaches. These augmentation and novel monotherapy interventions offer promise in allowing more patients to improve. For the most refractory cases, neurosurgery may be considered, though only as a last resort after less invasive treatments have been given adequate trials.

Summary In the future, advances in our understanding of OCD and its brain mechanisms may refine existing interventions and yield new treatment options. Ultimately, these efforts may lead to a precision medicine approach to treating OCD by allowing clinicians to match optimal treatment strategies to each individual patient.

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Authors and Affiliations

  1. Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Dr, Unit 69, New York, NY, 10032, USA

    Marina Gershkovich Ph.D., Michael G. Wheaton Ph.D. & H. Blair Simpson M.D., Ph.D.

  2. Barnard College, Columbia University, New York, NY, USA

    Michael G. Wheaton Ph.D.

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  1. Marina Gershkovich Ph.D.
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  3. H. Blair Simpson M.D., Ph.D.
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Correspondence to Marina Gershkovich Ph.D..

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Conflict of Interest

Dr. Gershkovich declares that she has no conflict of interest. Dr. Wheaton declares that he has no conflict of interest.

Dr. Simpson has received research support from the National Institutes of Health (NIH), New York Presbyterian Youth Anxiety Center, and New York State Office of Mental Health.

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With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

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Gershkovich, M., Wheaton, M.G. & Simpson, H. Management of Treatment-Resistant Obsessive-Compulsive Disorder. Curr Treat Options Psych 4, 357–370 (2017). https://doi.org/10.1007/s40501-017-0127-8

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